Syphilis in Canada: What You Need to Know
Syphilis Rates in Canada
In Canada, syphilis rates have been rising steeply since 2014 among the gay, bisexual and other men who have sex with men (gbMSM) population.
With the use of pre-exposure prophylaxis (PrEP) to prevent HIV, an increase in condomless sex amongst gbMSM was observed, which can facilitate the transmission of sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia.
What is Syphilis?
Syphilis is a bacterial STI caused by T. pallidum. The highest risk of transmission is when in direct contact with the lesion, but the lesions are not often visible and can be internal. Some ways syphilis can be passed include:
Anal, oral or vaginal sexual contact
Pregnancy or childbirth from a pregnant parent with syphilis to their child
Sharing equipment for injecting drugs
Sharing sex toys
Deep wet kissing
Sores from syphilis can be an entry point for HIV and other STIs to get inside the body.
Symptoms of Syphilis
Syphilis has 4 stages: Primary, secondary, latent (asymptomatic), and tertiary. If untreated, syphilis infections can lead to severe complications.
Primary Stage:
After an incubation period of around 14 to 21 days, syphilis presents as one or more small, painless open sores (often called a chancre). The chancre or sore is firm and painless, can be on the genitals, mouth, skin, or rectum, and will heal in 3 to 6 weeks if untreated. If untreated, the infection typically progresses to an asymptomatic stage or ‘early latent’ syphilis followed by secondary syphilis.
Secondary Stage:
This stage can include a rash or sore affecting any area of the body. Often the rash presents itself on the palms and/or soles of the feet, which can help distinguish it from many other causes of rash. The rash is often red or reddish-brownish and usually does not cause an itch. Other symptoms can include swollen lymph nodes, fever and fatigue.
Latent Stage:
This stage is when there are no symptoms, or visible signs of the infection, and it may last for years.
Tertiary Stage:
Without treatment syphilis may or may not progress to this stage. In this stage, syphilis can affect many internal systems and organs, such as the brain, eyes (ocular syphilis), ears (otosyphilis), heart or blood vessels (cardiovascular syphilis), and the central nervous system (neurosyphilis). Neurosyphilis can occur anytime after the syphilis infection and requires intravenous antibiotics for cure. For people living with HIV(PLHIV), neurosyphilis is more common, particularly in untreated HIV infection. When access to diagnosis and treatment of syphilis, neurosyphilis and its complications are uncommon. However, particularly when treatment is delayed, the damage done to the neurological system cannot always be fully reversed by antibiotic treatment.
These are some of the manifestations of an untreated syphilis infection that’s reached the tertiary stage:
Ocular syphilis: visual disturbances and blindness
Otosyphilis: dizziness, ringing/buzzing (tinnitus), and hearing loss
Neurosyphilis: severe headaches, muscle weakness and/or trouble with muscle movements, and changes to one's mental state including challenges with focusing, memory, decision-making, and personality change.
Testing for Syphilis
Routine syphilis is recommended for all sexually active gbMSM who have new sexual partners and/or whose sexual partners have had new partners since previous testing. If a patient or their partner detects something unusual on their body, such as any physical manifestations of syphilis, they should visit their physician for assessment and testing, and treatment as indicated. Screening is also recommended for sex partners who may have syphilis.
The standard test for syphilis requires a blood draw at a clinic or laboratory. In people with primary or latent syphilis, the blood tests may not always work. If syphilis is suspected but the test results are negative, it is recommended that doctors repeat the test several weeks later and also consider using tests that look specifically for the antibodies to T. palladium. In some cases, syphilis can also be diagnosed by swabbing an infectious chancre and examining the sample.
Having had syphilis does not make you immune to future syphilis infections, and routine testing is recommended.
Treatment and Harm Reduction
Most cases of syphilis are treated with penicillin (or doxycycline for those with an allergy to penicillin), although the doses and route of penicillin differs depending on the stage of infection. If syphilis is diagnosed within a year of infection, it can usually be treated with a single course of injections. It is important to note that this dose is inadequate for people with neurosyphilis. Individuals who have had syphilis for more than a year need to take a higher dose of the medication for longer. HIV+ individuals have the same recommended treatment as individuals who are not HIV+. Additional doses have not been shown to be more effective for HIV+ individuals. The recommended follow-up after syphilis infection includes serial syphilis serology tests, which helps to ensure that syphilis has been adequately treated.
To prevent syphilis infections, consistent and correct condom use is recommended during sex. Talk to your sexual partners about their history of STIs. Get tested and treated frequently - every three months - if you are sexually active. Newer studies have demonstrated the efficacy of doxycycline, an antibiotic, in preventing syphilis infection when taken soon after condomless sex. This practice is known as doxy post-exposure prophylaxis (doxy-PEP). However, there are concerns that exist surrounding the risk of resistance to antibiotics.
Sex after syphilis
It takes time for your body to recover from syphilis. Even though you may feel better after syphilis treatment, there may still be the germs that cause syphilis in your body. Consult with your healthcare provider when you can resume sexual activity. It is recommended re-screening for syphilis 3, 6, and 12 months after treatment.
Stigma
When possible, it helps to speak with sexual partner(s) about previous testing dates and results. However, stigma does exist surrounding STIs and conversations regarding STIs, which can be a barrier to this discussion. You can choose when, where, and how to have this conversation about STIs in order to facilitate the most comfortable conversation possible. Your sexual partners’ regularity with testing, their sexual encounters, and other factors may be helpful in making an informed decision about the type of sex you want to have with them, and/or may lead you to decide to get tested sooner than your typical screening schedule. There is no “right” or “wrong” decision. Taking care of your sexual health and well-being is crucial for satisfying sexual experiences and supporting your emotional, mental, and physical health.
Source: https://www.catie.ca/sites/default/files/2023-08/fs-syphilis-EN-2023-07-31.pdf
Source: https://gmsh.ca/wp-content/uploads/2023/10/GMSH-Fact-Sheet-Syphilis-2023-final.pdf
